Removal of intrauterine contraception with non-visible threads: a case series

(1) To review management of a series of women referred for removal of intrauterine contraception (IUC) with non-visible threads. (2) To establish whether the device was likely to have been placed at the fundus at insertion. (3) To document removal success rates in a community sexual health (CSH) setting.

A retrospective review of a series of 76 women seen by the author between April 2016 and October 2017 in a specialist CSH clinic for removal of IUC with non-visible threads.

After ultrasound scan (USS) assessment 67 women underwent a removal procedure. Sixty-two devices (92.5%) were successfully removed. Uterine instrumentation beyond the internal os was required in 43 removals, enabling comparison of uterine cavity length with the length of IUC and threads. Such comparison suggested 39/43 (91%) devices were not fundal at insertion and that non-visible threads were likely to have been caused by the device moving to the fundus post-insertion under the influence of uterine contractions, leading to retraction of the threads.

Removal of IUC with non-visible threads can be successfully done in a CSH setting with ultrasound availability. Non-fundal placement of IUC at insertion is likely to be a significant cause of non-visible threads.